Most of my clients have had some version of the same experience with healthcare: they describe what’s wrong, someone listens, there’s a general direction, lofty goals are prescribed, then it’s mostly up to them to figure out what to do with it.
The process I use starts with the assumption that behavior change is hard and life is messy.
Case conceptualization before treatment begins:
Before we start formal treatment, I write a structured account of what’s triggered coming into see me, what’s maintaining the patterns you’re dealing with, the relevant history, and what the clinical evidence suggests about what tends to work. I prepare a working document that outlines these findings.
This serves a specific function: I’ve come to understand your situation, but no one can ever know your situation as well as you. I invite my patients to read it, push back on it, and tell me where I’ve gotten something wrong. Some clients read it and say yes, exactly right. Others read it and clarify something I’d missed.
Specific, measurable treatment goals:
“Reduce anxiety” isn’t a treatment goal — it’s a direction. A treatment goal is specific enough that six weeks from now, you’d know whether you’re moving toward it or not.
At the start of treatment, we agree on what we’re working toward in terms concrete enough to evaluate. Knowing what you’re trying to change and how to tell whether what you’re doing is working.
Progress reviews every six to eight weeks:
We step back from the session-to-session work and evaluate: what has changed, what hasn’t, and what parts of the approach need adjustment. If something isn’t working, that’s important clinical information. Identifying it and recalibrating is more useful than continuing with a plan that isn’t moving.
The methods:
I use acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), motivational interviewing, mindfulness, and related evidence-based approaches. These have published efficacy data. You can learn more about them and don’t have to blindly take my word for what should help.
On collaboration:
The framework is structured. The work inside it isn’t rigid. Together we have a series of clinical conversations guided by a plan we’ve agreed on and can change.
Personalized care is the gold standard of healthcare. If a particular approach doesn’t resonate with how you think, that’s worth knowing.